Essay Program

Thursday, February 26, 2015

Nowadays, countless glossy brochures celebrate modern dentistry as innovation and progress. The protagonists don’t even hesitate to fantasize about a miracle explosion of knowledge in dentistry. If one takes a closer look, it becomes apparent that this progress is a Potemkin Village as it mainly affects prosthodontics: We surely are improving in replacing teeth. But the art of restoration of natural albeit flawed teeth is not only in stagnation since about a 100 years but yet in regression. Our dilemma in restorative dentistry shows that essential knowledge for the solution of difficult and complex cases has been lost.

In my presentation I will show and prove on a scientific base, that “once upon a time” we already knew better.

Learning Objectives:
After the presentation the participants will:

Understand why the current gold standard protocol in endodontics fails ever so often – even in simple cases

Understand the emergence of the obvious dilemma in apparently modern endodontic treatment and why the failure rate is highly inevitable

Learn how to increase their own endodontic success rate predictably by a medically justified therapeutic approach – even in very difficult cases

DR. TIMOTHY HESSFacial Aesthetics: Looking Beyond Enamel And Gingiva

The Doctor of Dental Medicine or Dental Surgery is not merely a barber surgeon. The dentist possesses an intimate knowledge of head and neck anatomy, disease processes and craniofacial conditions. We have surgical experience that surpasses many other health care professionals. Administration of Botulinum toxin and dermal fillers for aesthetic or therapeutic procedures of the head and neck is a natural extension of the dentist’s skill set. Facial aesthetics involves looking beyond the enamel and gingiva and addressing the tissues that frame a smile.

Learning Objectives:

A review of the dentist’s existing knowledge of head and neck anatomy to illustrate why we are the logical choice as a clinician to address facial aesthetics.

A discussion of physical changes that occur to the hard and soft tissues of the head and neck over time.

An introduction to common oral medicine therapies and aesthetic applications of Botulinum toxin and dermal fillers.

Toxic reactions elicited by dental materials, like silicate cements, amalgam and later resin based composites were evaluated in order to prevent adverse effects and to create inert or tolerated materials. Legal regulations have been installed worldwide and standard testing methods have been developed. In a next step, bioactive materials, which induce tissue reactions, have become the center of interest, like calcium hydroxide or tricalcium silicate phosphate cements; e.g. by evaluating biomineralization induction. Finally, the generation of new dental tissues, like pulp tissue, involves a new class of dental materials (scaffold materials), which interact with (stem/progenitor) cells, degrade in a controlled way and are finally replaced by new tissue closely resembling the destroyed tissue. Thus, our view of material-tissue-interactions developed from formerly merely preventing negative effects to today positively influencing and regenerating contacting tissues.

Learning objectives

How to prevent adverse effects; e.g. local damage (to the pulp and to the gingiva), or allergies.

How old (calcium hydroxide) and new (tricalcium silicate phosphate cements) materials induce biomineralization.

The role of scaffold materials in the regeneration of new dental tissues.

DR. PAUL BRUNTONA Risk-Based Approach To Patient Management

Increasingly we must consider the risk, benefit and outcomes for the treatments that we provide for our patients. Risk assessment is a valuable tool in informing both ourselves and our patients when planning treatments but also allows us to provide treatment where the best outcome can be achieved. It is important to consider the evidence that underpins risk assessment.

Learning objectives
At the end of the lecture the audience will have an understanding of:

A General Dentistry update reviewing the most influential and clinically significant materials, methods and techniques which are influencing and changing today’s general practice. A review of dental materials which offer dentists additional options for improving patient care, increasing restorative predictability, while providing the general practice an improved profitability.

Learning objectives
For each participant to understand:

The significance of the supporting bone, joints, tissue and teeth while maintaining a healthy function of Occlusion. How to provide socket site preservation following our extractions, and the significance/role of implants today in the restorative practice, and tissue grafting for proper root coverage.

How to address the challenges in our prosthodontics success and predictability with every crown seat and record we take. Points to include temporization, impressions, tissue management and other clinical challenges we face regularly.

The clinical challenges and improve in the Posterior Composite placement and understand critical steps in our composite success. Posterior composites are indeed the bread and butter of the restorative dental practice.

DR. FRED EICHMILLERThe Changing World Of Dentistry: A View From The Dark Side

There are rapidly evolving factors that are shaping our industry. Our business climate is moving towards different models of delivery. Education and attitudes are changing how our workforce is evolving. Disease trends are having a profound impact on demand. These trends don’t signal the apocalypse, but rather a change in how we will be delivering care.

Learning Objectives
For each participant to understand:

The workforce and business model changes occurring in dental practice.

The economic drivers behind these changes and how they are shaping the future for our dental delivery system.

The trends in dental disease and how these are impacting the business of dentistry.

A biomimetic clinical protocol for class II composite restorations, first published in the JADA in 2002, will be presented along with further development in the last 12 years; the same biomimetic principles will be presented for both the anterior restoration and the full-mouth rehabilitation to introduce the “Cycle of Tooth Preservation” for the natural dentition.

Learning objectives:

Understand a stress-reducing technique: maturation of the bond, layering and curing protocols

Comparing a stress-reduced direct technique with traditional techniques available for the restoration of posterior teeth

Become familiar with the stress-reducing direct composite (SRDC) technique through a step-by-step clinical protocol

Friday, February 27, 2015

Symposium: Cracked Teeth: What We Know And What We Don’t

DR. TOM HILTONWhat Have We Learned?

This first session will provide an introduction to the half-day interactive course on cracked teeth. It will provide some historical perspective on occurrence of cracked teeth and epidemiologic data. It will also relay the results of research done regarding crack tooth characteristics, as well as outcomes of studies done examining impact of various treatment for cracked teeth.

Learning objectives:

Become familiar with the prevalence of cracked teeth.

Understand anatomic characteristics in teeth that pertain to crack arrest or progression.

Become familiar with data from the peer-reviewed literature regarding cracked-tooth characteristics and cracked-tooth treatment.

DR. JACK FERRACANEWhat Are We Learning Currently?

Intro PBRN concept and how much of current research in cracked teeth is taking place in PBRNs. Current studies on cracked teeth: data from national network, PROH in-vitro study with extracted teeth. Challenges of cracked teeth research

Learning objectives:

Describe current efforts in practice-based research as they relate to studying the clinical characteristics and outcomes of teeth with cracks

Explain characteristics of teeth with cracks and how they may be utilized to develop a crack tooth risk assessment tool

The final sessions will look at today’s emerging technologies for assessing structural integrity of teeth that are in development or currently commercially available. Today’s restorative materials provide the ability to replicate nature with materials that look like nature but may react differently biologically and mechanically.

Table Clinic Program 2015

AAGFO membership is dedicated to direct gold as an alternative to other materials that may have inferior clinical longevity. We take pride in offering educational opportunities for practitioners, students and dental educators. Annual meetings are held at dental schools and military clinics to promote greater skill in the use of direct gold foil.

Changes in the preclinical curriculum of operative dentistry driven by the Millennial Generation

The characteristic profile of Millennial generation students has been driving many educational reforms. This table clinic describes the recent strategies implemented in our operative dentistry preclinical curriculum to address the manner by which Millennial students learn

Learning objectives:

How the Millennial generation of students learn and how they engage in operative dentistry preclinical courses.

New curriculum strategies to support the development of psychomotor skills, self-evaluation and clinical judgment.

Lessons learned from our experiences on the recent changes made in our preclinical education.

As patient demand for esthetic restorations has increased in dentistry, so has the use of resin composites and ceramics. In some situations these materials are durable and predictable but their success is questionable in situations where the operating field is difficult to isolate or where there is not sufficient enamel for predictable resin bonding. The margin elevation technique alleviates these issues and may increase longevity of bonded restorations.

Learning objectives:

Indications and advantages for utilizing the margin elevation technique

Evidence based material selection for margin elevation technique

Step-by-step protocol from prep to completed restoration for margin elevation.

Restoration of endodontically treated teeth often present challenges to the clinician. The conventional treatment protocol of placing an intra-radicular post and core to aid the retention of an overlying crown is time consuming procedure and may take several visits. In this table clinic the use of a monoblock CAD/CAM fabricated post/core and crown as a single visit alternative restoration for endodontically treated teeth will be discussed.

Learning Objectives:

The participant will be able to discuss different alternative restorations of endodontically treated teeth.

The participant will compare the available materials for CAD/CAM fabricated post/core crowns.

The participant will be ale to describe the preparation design and fabrication for this single visit CAD/CAM technique.

Composite resin has become a prominent material in operative dentistry. Many of the benefits of composite allow the clinician to take a less invasive approach to treatment. A conservative approach to caries management will be highlighted in this table clinic.

Learning Objectives:

State the five principles for a less invasive approach in the management of dental caries.

Understand the role of composite resin in less invasive operative treatment

Learn predictable method for the repair of composite resin restorations.

A laboratory technique for cast gold using the refractory die method (Sit down clinic)

A laboratory technique will be presented and described on how to fabricate intra and extra-coronal cast gold restorations using a refractory die technique. The technique has proved to be efficient and extremely accurate in the laboratory and clinical setting. Finished or unfinished castings exhibit a high degree of marginal adaptation and fit on natural teeth and dies due to the virtual elimination of wax pattern distortion as a result of the technique.

Learning Objectives:

A refractory die technique for consistently producing intra and extra-coronal cast gold restorations of various configurations.

Extremely accurate and precise castings can be produced because distortion of the wax pattern has been eliminated with the technique.

A comparison of the gingival marginal adaptation of the conventional resin based composites and the bulk fill resin based composites in class II preparations.

Technology in the field of dentistry is essential and with all the advancements of restorative materials, bulk fill resin bonded composites were relatively recently introduced to clinicians. This table clinic presents the different types of bulk fill resin based composites and compares their gingival marginal adaptation to the conventional resin based composites.

Learning Objectives:

Introduction to the different types of bulk fill RBC’s advertised in the dental market.

Discussing factors affecting the gingival adaptation of RBC’s

Comparing the gingival marginal adaptation of different bulk fill RBC’s and conventional RBC’s.

Establishing and restoring a beautiful smile with minimal intervention is a key element in today’s dental practice. This table clinic will present cases with superficial enamel defects that have been treated with the microabrasion technique. Emphasis will be given to proper case selection, treatment sequencing and material selection.

Learning Objectives:

Understand the case selection criteria for enamel micoabrasion.

Compare advantages and disadvantages in relation to other treatment modalities.

Master the enamel microabrasion technique on models provided during the table clinic.

Initial enamel caries is marked by the whiteness of the lesions leaving esthetic disadvantages. Peroxide bleaching of the teeth with white spot lesions can camouflage their distinguished white appearance. Bleaching could be a noninvasive approach for the esthetic enhancement of the white spot lesions while maintaining the structural integrity of the initial caries.

To understand the color change of the carious and bleached enamel.

To consider potential alterations in the structural characteristics of teeth subsequent to the bleaching procedures.

To develop a protocol combining remineralization and bleaching treatment.

This table clinic will discuss the widely versatile “Essix retainer” and its many uses. From stay plates to occlusal appliances and esthetic provisional restorations, vacuum-formed thermoplastics offer a lot of advantages to the practicing clinician. Techniques and suggestions for in-office fabrication are offered.
Learning objectives:

Types of appliances that can be fabricated from vacuum-formed thermoplastics.

Fabrication workflow for “Essix retainers” and their derivatives.

Suggestions for fabrication, delivery, and home care for best longevity of these appliances

The quality of traditional fixed prosthodontic impressions received at commercial laboratories

An evaluation of conventional impressions arriving at commercial dental laboratories was performed. A total of over 1100 impressions were evaluated during the study. Data regarding error type, frequency, and type of restoration requested are presented.

Learning Objectives:

The common errors found in traditional impressions and how many can be corrected.

The frequency at which different restorations types are being ordered.

Predictable protocols for cementation of four categories of CAD-CAM restorations

Appropriate surface treatment in ceramic restorations is an important step in the cementation process and should be conducted for each type of ceramic. The clinician should give special consideration to the use of adhesives, resin cements, and field isolation. A clinical case illustrating appropriate case selection and step by step cementation procedures for an onlay (IPS e.max CAD) will be presented.

Learning objectives:

Differentiate between the different tooth colored restorative materials for CAD-CAM systems.

The purpose of this study was to evaluate the fracture resistance and microleakage of three different CAD/CAM ceramic and cast gold inlay restorations when cemented with three different cements. All the restorations went through a fatigue failure resistance and microleakage to assess the integrity of the restorations.

Learning Objectives:

The application of digital dentistry in fabrication of CAD/CAM intracoronal restorations.

Have a better understanding of fracture resistance and microleakage of several CAD/CAM materials and cast gold inlay restorations.

Interpretation and assessment of the behavior of different CAD/CAM restorative materials cemented with various cements.

Effect of various materials to support undermined cusps: Strength comparison

Numerous studies have shown that conservation of tooth structure is the primary factor to producing a higher quality and longer lasting restoration. With materials which mimic the properties of natural tooth structure, it is possible to allow undermined cusps to remain supported by block-outs of high strength, adhesively retained resins and glass ionomers. Thus provide the opportunity to conserve tooth structure, maintain occlusal relationships and potentially extend restoration survival.

Learning Objectives:

To increase knowledge on different dental materials that act as dentin analogues which provide support to undermined enamel

The maxillary midline diastema can be an esthetic concern to many patients. The literature supports that its etiology is multifactorial: consequently many treatment options exist to try to correct it. One of the most common procedures to restore the MMD is orthodontics. This modality offers the patient a conservative approach but sometimes it is not enough.

Bruxism is an activity of major concern to dentists because of its several harmful consequences to the stomatognathic system, including tooth destruction, breakage of dental restoration, headaches, muscle pain, and exacerbation of temporomandibular disorders (TMD). However, grinding and / or clenching is much more than tooth wear. Patients with bruxism symptoms need to be screened for other comorbid medical conditions (eg, SDB, depression, mood disorders) before undertaking any treatment approach.

Learning Objectives:

Bruxism may be positively associated with subgroups of TMD (e.g. myofacial pain).

Stress and bruxism are competing factors that may be present simultaneously in patients with myofascial pain.

In the treatment of bruxism symptoms it has to be ensured that patients of specific subgroups could potentially also suffer from nocturnal breathing disorders and therefore need further diagnostics.

A case presentation of treatment approach for a twelve year old patient with a complicated crown fracture. The treatment goal aimed to maintain pulp vitality with best esthetic result by rebonding the broken tooth fragment.

Learning Objectives:

How to diagnose dental hard tissue traumatic injuries

Treatment decision making and possible outcomes in case of complicated crown fracture

A conservative treatment approach in case of complicated crown fracture in order to maintain pulp vitality and to provide maximumesthetic result.

This table clinic will focus on evidence-based techniques in caries excavation and how these techniques have transformed over time. Past and current approaches and criteria will be compared and contrasted. Current controversies in implementation for change based on evidence will be discussed.

Learning Objectives:

Past and current criteria for caries removal outcomes based on evidence in the literature

Current techniques and aids for appropriate caries removal outcomes and how these techniques have changed over time based on new evidence in the literature

Consider discussions about implementation of change in the amount of tooth substance removed in caries excavation and identification of differences between infected dentin and affected dentin.

Consistency of caries detection techniques and treatment planning in North American dental schools

Dental schools have advocated the assessment of caries risk as a tool in comprehensive treatment planning. Understanding and implementation of this tool, however, may vary between institutions showing inconsistencies. These inconsistencies are partly related to the variation among dentists when diagnosing caries and specific methods to detect and quantify carious lesions. Our study design is to determine if there is consistency in caries detection, prevention and management.

Learning Objectives:

Different approaches taken by the North American dental schools for caries diagnosis.

Understanding the idea of how to diagnose decay and options available in the market.

About how the North American dental school approaches for the treatment of the decay.

Digital caries detection: research review of using digital intrs-oral and radiographic programs to augment diagnosis and treatment of caries. What are the methods available to augment caries detection, how successful are these media, and does it actually matter?

Learning Objectives:

What are various methods available to augment initial caries detection in virgin and restored teeth?

Airway function and dysfunction: It’s relavance to dental and general well being

Sleep disordered breathing, TMD, dental crowding, nocturnal bruxism, diurnal clenching, craniofacial distortions, ADHD, and many other medical sequela are considered signs and symptoms of the deficient airway. This table clinic will address a wellness approach to dental health in comparison to disease management.

Learning Objectives:

The worn dentition can be associated more with the “constricted airway” versus a “constricted” chewing cycle.

Aberrant craniofacial development poses a major risk factor for TMD than centric relation.

Resin modified glass ionomers are a hybrid material of glass ionomer and composite resin. These hybrids provide their own strengths and limitations independent from the materials that they’re composed of. This table clinic will review when and how to use resin modified glass ionomers.

Xerostomia is a condition that affects 10-29% of the population. Recognizing potential risk factors and diagnosing it early is a great way to prevent severe cases and other problems. This presentation will address diagnosing xerostomia, treating it, and restorative recommendations.

Comparison of fracture resistance of ceramic crowns with various composite build-up materials

Numerous buildup materials and techniques are used for making a core for molars to replace missing tooth structure. These build up materials involve placing peripheral shelves and pins to hold the core in place. This table clinic wil show a few simple procedures to provide a core foundation preserving the intrinsic strength of remaining tooth structure and a more predictable final restoration.